Abstract
Introduction: a subsidized community health insurance programme in Kwara State, Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme´s suspension on enrollees´ healthcare utilization. Methods: a mixed-methods study was carried out in Kwara State, Nigeria, in 2018 using a semi-quantitative cross-sectional survey amongst 600 former Kwara community health insurance clients, and in-depth interviews with 24 clients and 29 participating public and private healthcare providers in the program. Both quantitative and qualitative data were analyzed and triangulated. Results: most of former enrollees (95.3%) kept utilizing programme facilities after the suspension, mainly because of the high quality of care. However, majority of the enrollees (95.8%) reverted to out-of-pocket payment while 67% reported constraints in payment for healthcare services after suspension of the program. In the absence of insurance, the most common coping mechanisms for healthcare payment were personal savings (63.3%), donations from friends and families (34.7%) and loans (11.8%). Being a male enrollee (odd ratio=1.61), living in a rural community (odd ratio =1.77), exclusive usage of Kwara Community Health Insurance Programme (KCHIP) prior to suspension (odd ratio=1.94) and suffering an acute illness (odd ratio=3.38) increased the odds of being financially constrained in accessing healthcare. Conclusion: after the suspension of the scheme, many enrollees and health facilities experienced financial constraints. These underscore the importance of sustainable health insurance schemes as a risk-pooling mechanism to sustain access to good quality health care and financial protection from catastrophic health expenditures.
| Original language | English |
|---|---|
| Article number | 10 |
| Number of pages | 16 |
| Journal | Pan African medical journal |
| Volume | 41 |
| DOIs | |
| Publication status | Published - 5 Jan 2022 |
Bibliographical note
Funding Information:We wish to acknowledge the support of the Kwara State Government to the research team.Funding: though the PharmAccess Foundation funded this study and one of the authors work at the company, the study was not influenced by his participation in the design, data collection and manuscript writing.
Publisher Copyright:
© Oladimeji Akeem Bolarinwa et al.
Funding
We wish to acknowledge the support of the Kwara State Government to the research team.Funding: though the PharmAccess Foundation funded this study and one of the authors work at the company, the study was not influenced by his participation in the design, data collection and manuscript writing.
Keywords
- Community-based
- Health insurance
- Kwara
- Suspension
